| NPI | 1891526489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN T WOLTER Licensed Clinical Social Worker 224-406-2056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-09-16 |